As DHR chairman, Bruce Cook helps guide policy -- and a $3.2 billion budget -- for the huge state agency responsible for delivering health and social services to mostly lower-income Georgians. As a business owner, Cook operates Choosing the Best, a Smyrna-based firm that publishes abstinence materials used by county health departments, local school systems and some of the community-based teen centers that are operated by the very agency Cook oversees.
That potential blurring of the line between public service and private commerce has earned Cook numerous critics since his appointment to the DHR post last fall by Gov. Sonny Perdue. Last week, however, Cook seemed oblivious to the implications of using his public position in a highly visible fashion to drum up business for his company -- at a conference funded by his own agency.
Cook set the tone at the start of his address when he announced to the crowd, "I wear two hats here," as DHR chair and private businessman -- effectively offering a concise visual analogy for what some viewed as a conflict of interest by a public official.
In Perdue's first executive order after taking office in January 2003, he set forth a new code of ethics for state employees and appointees that reads: "An appearance of conflict exists when a reasonable person would conclude from the circumstances that the employee's ability to protect the public interest, or perform public duties, is compromised by personal interests."
The state attorney general's office maintains that, "As a general rule, Georgia's ethics laws prohibit a board member who oversees an agency from transacting business with that agency," according to spokesman Russ Willard.
"We were surprised that he promoted his program and even flashed a picture of his book on the overhead projection," says Jennifer Dupree, who attended the two-day KSU conference as co-chairperson of the all-volunteer Cobb Teen Pregnancy Prevention Coalition. "I'm concerned about the appropriateness of his actions."
Delivering the keynote address at the Oct. 21 conference, Cook lauded the effectiveness of his company's abstinence-education programs; criticized programs by his competitors; cited his own book about teen abstinence, The Big Talk Book; and wrapped up his speech by denouncing abstinence programs which, unlike Choosing the Best, actually address the subjects of contraception and safe sex.
The audience was composed of more than 250 representatives from county health departments, local school systems, teen centers and a slew of nonprofit agencies from across northern Georgia -- in short, a collection of current and potential customers for Cook's business.
Just outside the meeting hall, a Choosing the Best employee waited next to the company's display with order forms for the various manuals, videos and classroom materials that Cook's firm sells.
"If this isn't a conflict of interest, I don't know what is," says a salesperson for one of the half-dozen other companies exhibiting their wares at last week's conference. "It struck me as an unethical business practice." The salesperson has asked that her name not be used out of concern that Cook could use his influence to hinder her company's efforts to sell its products in Georgia.
Asked later by CL why he would have promoted his own products while making a public appearance as DHR chair, Cook says he was asked to.
"I appeared in both roles [board chair and businessman] at the request of the conference organizers," he says, referring to KSU officials who coordinated the abstinence conference with funding from the Division of Public Health, a sub-department of the DHR.
Besides, Cook says, other businesspeople invited to speak at the conference were using the opportunity to hawk their wares.
"That's going to be the nature of a conference like this," he explains.
Cook began courting controversy long before last week.
Many of his more vocal critics -- including supporters of Planned Parenthood and the Georgia Campaign for Adolescent Pregnancy Prevention -- have accused Cook of politicizing public health care in Georgia by attempting to impose a far-right-wing social agenda on the DHR.
Before launching Choosing the Best in 1996, Cook was president of Rapha Counseling Services, a purveyor of "Christ-centered psychiatric treatment" and "biblically based counseling services."
Soon after Cook joined the agency's board in September 2003, the DHR recommended shutting down 39 teen centers around the state that offer counseling on contraceptives, even though a significant portion of the centers' funding comes from federal grants. Critics of the proposal argued that Cook and his allies on the DHR board objected to the fact that several of the teen centers distribute condoms.
Just last month, in a closely watched decision, the DHR board voted to keep the remaining teen centers open but imposed new policies mandating that at least half of the centers' educational content adhere to strict, abstinence-only guidelines. The policy further decrees that each center form an advisory committee of local parents to help determine which programs will be offered by the center and that condoms "may only be distributed in a clinical setting by a health-care professional."
Georgia's continued shift away from traditional sex-ed toward abstinence-only educational programs, in which safe sex is never discussed, has been going on for several years now, says Marion Howard, an ob-gyn professor at Emory who helped develop one of the first teen abstinence programs to achieve national prominence. Her "Postponing Sexual Involvement," developed with colleague Marie Mitchell in 1983 when they headed Emory/Grady Teen Services, has been adopted by hundreds of county health departments and school systems, from Oregon to Kentucky.
Howard says she was disappointed when Cook attacked the effectiveness of her program in his speech at the conference, which she also attended. It's not because she stands to lose money -- "Postponing Sexual Involvement" is owned and marketed by the nonprofit Grady Health Systems -- but because she believes young people need both abstinence education and reproductive health information, including methods of protection from pregnancy and STDs.
As more and more Georgia counties and school systems switch over to abstinence-only education, the list of competitors for Cook's Choosing the Best program narrows, while his market widens.
As Howard says, "I admire his chutzpa."